Abstract: Objective: To evaluate the application value of reflectance confocal microscopy (RCM) in the follow-up of localized scleroderma. Methods: Retrospectively analyze the RCM image characteristics of 14 patients with localized scleroderma confirmed by histopathology in our hospital during the follow - up period (before treatment, 4-6 months and 12-15 months after treatment), and analyze the correlation with the efficacy of the patients. Results: After 12-15 months treatment, 13 out of 14 patients showed improvement, with decreased mLoSSI and LoSDI scores. One patient's condition deteriorated, with no change in the mLoSSI score and an increased LoSDI score. RCM changes in the 13 improved patients: In 6 patients, the collagen fibers recovered to a fine reticular structure, and in 7 patients, the dermal collagen density decreased; the dermal reflectance index of all 13 patients decreased; the clarity of the dermo-epidermal junction was significantly improved in 7 patients, and dermal microcirculation was visible in 4 patients. In the patient with deteriorated condition, there were no obvious improvements in the collagen fiber morphology, dermal reflectance index, and clarity of the dermo - epidermal junction. Conclusion: RCM is an effective tool for monitoring the collagen morphological changes and vascular alterations in localized scleroderma.

Key words: localized scleroderma, reflectance confocal microscopy, skin fibrosis